Hydriatic Treatment of Scarlet Fever in Its Different Forms

PART I.. Description of Scarlet-Fever.

DESCRIPTION OF SCARLET-FEVER.

1. SCARLET-FEVER, OR SCARLATINA,

is an eruptive fever, produced by a peculiar contagious poison, and distinguished by extreme heat, a rapid pulse, a severe affection of the mucous membranes, especially those of the mouth and throat, and by a burning scarlet eruption on the skin.

2. DIVISION OF THE PROCESS OF THE DISEASE INTO PERIODS.

Its course is commonly divided into four distinct periods, viz.: the period of incubation, the period of eruption, the period of efflorescence, and the period of desquamation; to which may be added: the period of convalescence.

3. PERIOD OF INCUBATION, OR HATCHING.

The time which passes between the reception of the contagious poison into the system and the appearance of the rash, is called the period of incubation; incubation or incubus meaning, properly, the sitting of birds on their nests, and figuratively, the hatching or concoction of the poison within the body, until prepared for its elimination. There is no certainty about the time necessary for that purpose, as the contagion, after the patient has come in contact with it, may be lurking a longer or a shorter time about his person, or in his clothes and furniture.

As in almost all eruptive fevers, so in scarlatina, the patient begins with complaining of shivering, pain in the thighs, lassitude, and rapidly augmenting debility; frequently also of headache, which, when severe, is accompanied with delirium, nausea and vomiting. The fever soon becomes very high, the pulse increasing to upwards of 120 to 130 strokes in a minute, and more; the heat is extreme, raising the natural temperature of the body from 98 to 110-112 degrees Fahrenheit, being intenser internally than on the surface of the body. The patient complains of severe pain in the throat, the organs of deglutition located there becoming inflamed, and swelling to such a degree that swallowing is extremely difficult, and even breathing is impeded. The tongue is covered with a white creamy coat, through which the points of the elongated papillae project. Gradually the white coat disappears, commencing at the end and the edges of the organ, and leaves the same in a clean, raw, inflamed state, looking much like a huge strawberry. This is called the strawberry tongue of scarlet-fever, and is one of the characteristic symptoms of that disease. There is a peculiar smell about the person of the patient, reminding one of salt fish, old cheese, or the cages of a menagerie.

4. PERIOD OF ERUPTION, OR APPEARING OF THE RASH.

Commonly, on the second day, towards evening, sometimes on the third, and only in very bad cases later, the rash begins to make its appearance, under an increase of the above symptoms, especially of the fever and delirium, and continues to come out for about twelve hours. Usually the eruption commences in the face, on the throat and chest; thence it spreads over the rest of the trunk, and finally it extends to the extremities. The minute red points, which appear at first, soon spread into large, flat, irregular patches, which again coalesce and cover the greater part, if not the whole, of the surface, being densest on the upper part of the body, particularly in front, in the face, on the neck, the inner side of the arms, the loins, and the bend of the joints. The scarlet color of the rash disappears under the pressure of the finger, but reappears immediately on the latter being removed. Sometimes the eruption takes place with a profuse warm sweat, which prognosticates a mild course and a favorable issue of the disorder. Together with the appearance of the rash, the disease develops itself also more internally: the inflammation of the mouth and throat increases; the tonsils and fauces swell to a high degree; the eyes become suffused and sensitive to the light; the mucous membranes of the nose and bronchia become also affected, the patient sneezes and coughs, and all the symptoms denote the intense struggle, in which the whole organism is engaged, to rid itself of the enemy which has taken possession of it.

5. PERIOD OF EFFLORESCENCE, OR STANDING OUT OF THE RASH.

During the first day or two of the period of efflorescence, which lasts three or four days, the above symptoms usually continue to increase. Sometimes, however, the patient is alleviated at once on the rash being formed. This alleviation always takes place when the rash comes with perspiration, and also under a proper course of water-treatment. If the rash continues to stand out steadily, the symptoms decrease on the third day; the patient becomes more quiet, the pulse slower (going down to 90 and even to 80 strokes per minute); the rash, then, gradually and steadily fades, and finally disappears altogether.--Sometimes the rash fades or disappears too early, in which cases, usually, the internal symptoms increase, the brain and spine become affected, and the situation of the patient becomes critical.

6. PERIOD OF DESQUAMATION, OR PEELING-OFF.

About the sixth or seventh day, the epidermis, or cuticle of the skin begins to peal off, commencing in those places which first became the seat of the rash, and gradually continuing all over the body. In such parts as are covered with a thin delicate cuticle (as the face, breast, &c.) the cuticle comes off in small dry scurfs; in such parts as are covered with a thicker epidermis, in large flakes. There have been instances of almost complete gloves and slippers coming away from patients' hands and feet.--The fever subsides entirely, and so does the inflammation of the throat and mouth, which become moist again. Also the epithelia, or the delicate cuticles of the mucous membranes, which have been affected by the disease, peal off and are coughed up with the tough thick mucus covering the throat, or they are evacuated with the faeces and the urine, forming a sediment in the latter.--Desquamation is usually completed in from three to five days; sometimes it requires a longer time; under hydriatic treatment it seldom lasts more than a few days. Whilst desquamation is taking place, a new cuticle forms itself, which, being exceedingly thin at first, gives the patient a redder color than usual for some time, and requires him to be cautious, in order to prevent bad consequences from exposure.--

Thus the disease makes its regular course in about ten days, and, under a course of hydriatic treatment, which not only assists the organism in throwing off the morbid poison and keeps the patient in good condition, but also protects him from the influence of the atmosphere, the patient may consider himself out of danger and leave the sick-room under proper caution, of which we shall speak hereafter.

7. THE PERIOD OF CONVALESCENCE,

under the usual drug-treatment, is, however, usually protracted to twice or thrice the duration of the disease, the patient being compelled to keep the house for five or six weeks, especially from fear of anasarca, or dropsy of the skin, frequently extending to the inner cavities of the body, and proving fatal. This dangerous complaint has been more frequently observed after mild cases of scarlet-fever than after malignant cases, probably from the fact that in mild cases the patient is more apt to expose himself, than when the danger is more obvious and all possible care is taken.--Sometimes also severe rheumatic pain, or rather neuralgia, in the joints, swelling of the glands, and other sequels prolong his sickness. I never observed a case of dropsy, or of neuralgia, after a course of water-treatment.

8. VARIETIES OF FORMS OF SCARLATINA.

The above is the description of scarlet-fever, as it most frequently occurs. But far from taking always that regular course, the constitution of the patient, the intensity of the epidemy and the virulence of the poison, the treatment and other circumstances influencing the development of the disease, cause several anomalies, from scarlatina simplex to scarlatina maligna, which too often baffles all the resources of the Medical Art.

9. SCARLATINA SIMPLEX, OR SIMPLE SCARLET-FEVER.

In the mildest form of the disease, called scarlatina simplex, or simple scarlet-fever, there is no inflammation of the throat, the fever is moderate, and the patient suffers very little. Unfortunately this form is so rare, that many experienced physicians never saw a case. Probably, it was a case belonging to this class, which was mentioned a number of years ago by one of the writers on Priessnitz's practice, when a lady with scarlet-fever joined a dancing party at Graefenberg, a case for reporting which the author has been ridiculed by the opponents of the Water-Cure, but which by no means belongs to impossibilities; for scarlatina simplex having been declared by eminent physicians (not of Priessnitz's school) to be "scarcely a disease," becoming fatal only through the officiousness of the doctor, and other physicians of note recommending cold rooms and open air through the whole course of the disease, or at least towards the latter part of it; I do not see why a patient under water-treatment should not be safer in producing perspiration by dancing than in sitting in a cold room or in walking in the open street. The fact, of course, is unusual, and I do not exactly recommend its practice, but it is not at all impossible, and ridiculing the reporter of it shows either ignorance of the disease or a bad will towards the new curative system, to which those are most opposed who know the least of it.

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